摘要
目的探讨骨科手术患者院内感染的临床分布特征及其与免疫功能的关系。方法选取2019年1~12月在我院行骨科手术的1200例患者为研究对象,术前均进行免疫功能指标检测。记录院内感染部位、病原菌情况,并进行药敏试验。根据是否发生院内感染将患者分为感染组和非感染组,比较两组患者免疫功能水平,并收集患者临床资料进行危险因素分析。结果骨科手术患者术后院内感染的发生率为4.25%(51/1200),其中以皮肤软组织、手术切口感染最多,感染率分别为25.5%和23.5%。共分离出86株病原菌,其中革兰氏阳性菌以金黄色葡萄球菌为主,有18株(20.9%),革兰氏阴性菌以铜绿假单胞菌和大肠埃希菌为主,分别为21株(24.4%)和17株(19.8%)。感染组CD4^+、CD3^+、CD4^+/CD8^+低于非感染组,CD8^+高于非感染组,差异均有统计学意义(P<0.05);感染组体液免疫功能指标IgA、IgG、IgM均低于非感染组,差异均有统计学意义(P<0.05)。多因素分析结果显示,手术切口类型、糖尿病、CD4^+、CD4^+/CD8^+、IgG与骨科手术患者术后发生院内感染密切相关(OR>1,P<0.05)。结论骨科手术患者术后院内感染致病菌以金黄色葡萄球菌、铜绿假单胞菌和大肠埃希菌为主,并且院内感染的发生与患者免疫功能下降密切相关,临床应针对相关危险因素进行合理干预,以降低感染风险。
Objective To explore the clinical distribution characteristics of nosocomial infection in orthopedic surgery patients and its correlation with immune function.Methods One thousand and two hundred patients with orthopedic surgery in our hospital from Jan to Dec in 2019 were enrolled as the research objects,and the immune function indexes were detected before operation.The infection site and distribution of pathogenic bacteria were recorded,and drug sensitivity test was carried out.The patients were divided into infection group and non-infection group according to whether there was nosocomial infection.The immune function indexes of the two groups were compared,and the clinical data of patients were collected for risk factor analysis.Results The incidence of postoperative nosocomial infection in orthopedic patients was 4.25%(51/1200).The most common infection was skin and soft tissue,and surgical incision with the infection rates of 25.5%and 23.5%,respectively.A total of 86 pathogenic bacteria were isolated,of which Staphylococcus aureus was the main Gram-positive bacteria,20.9%(18/86).Pseudomonas aeruginosa and Escherichia coli were the main Gram-negative bacteria,24.4%(21/86)and 19.8%(17/86)respectively.CD4^+,CD3^+,CD4^+/CD8^+T cells in the infection group were lower than those in the non-infection group,and CD8^+T cells were significantly higher than that in the non-infection group(P<0.05).IgA,IgG and IgM in the infection group were significantly lower than those in the non-infection group(P<0.05).The results of multivariate analysis showed that the type of incision,diabetes,CD4^+,CD4^+/CD8^+,IgG were closely correlated to the postoperative nosocomial infection(OR>1,P<0.05).Conclusion Staphylococcus aureus,Pseudomonas aeruginosa and Escherichia coli are the main pathogens of nosocomial infection in patients with orthopedic surgery,and the incidence of nosocomial infection is closely correlated to the decline of patients'immune function.Therefore,in order to reduce the risk of infection,reasonable intervention should be carried out according to the related risk factors.
出处
《中国现代医药杂志》
2020年第12期5-9,共5页
Modern Medicine Journal of China
基金
2019年东莞市社会科技发展(一般)项目(编号:201950715011796)。
关键词
骨科手术
院内感染
流行病学
病原菌
免疫功能
Orthopaedic surgery
Nosocomial infection
Epidemiology
Pathogenic bacteria
Immune function
